How to deal with the mental side of injury

We all have different reasons why we exercise. We all love different sports. We all gain different benefits from it. But the one similarity that I observe is that we all tend to enter a sort of grieving process when injury stops us from doing activities that we love.

I don’t know if any research has been done on it but I definitely find that my patients all go through very similar stages to the five stages of grief described by Elizabeth Kubler-Ross for when we lose a loved one. The five stages are denial, anger, bargaining, depression (I think calling it low mood in this case is more appropriate) and acceptance.

This grief can sometimes be so overwhelming for my patients that it stops them from doing the things that they need to do to help their injury recover. So it’s really important to understand that it’s normal to experience all of these emotions but that you need to find coping mechanisms, otherwise they can actually hinder your recovery.

This “grieving” process isn’t linear either. It’s normal to experience a mix of emotions. It’s normal to fluctuate between them e.g. finding acceptance one day just to feel angry and have a low mood another day.

In this article I’ll share with you the methods that I find help to get myself and my patients through this process. Here's the video from the livestream I did in the Sports Injury Group on this topic.

A little denial is natural…and sometimes useful

I don’t think I’ve met many people who don’t “test” an injury or try to train with some pain before they seek medical advice. And to be honest, some pains and niggles do just go away by themselves.

The key is to not enter into full denial mode and continue to train to the point where you’ve turned a small niggle into a full-blown injury. I’ve discussed my method of “safely” testing a niggle in last week’s blog post.

If you consult me at the point where something is just a niggle, I can usually help you to adjust your training so that you can continue exercising while your injury recovers.

My advice for the denial stage: Don’t hang around in the denial stage for too long. Be honest with yourself and if it’s not showing signs of improving, get the right advice as quickly as possible. This will significantly speed up your recovery process.

Be angry but don’t beat yourself up

Yes, fine – you may not have been in this situation if you had just done x, y or z but we all make mistakes and this will not be your last. Or maybe it was a stupid dog that ran in front of you and you’re not even to blame for the situation you’re in.

Anger is good and very normal but don’t allow it to get in the way of your recovery. As much as words like “learning experience” make my hair stand on end…this is exactly what you should use your injury for.

My advice for the anger stage: Instead of just being angry, think about what you can learn from this to take with you and avoid injury in the future.

I’m all for bargaining

You should know by now that I’m a great supporter of relative rest. Relative rest is the ultimate positive “bargaining” tool as it allows you to be active while your injury recovers.

Relative rest means that you only cut out or reduce the activities that really affect your injury. Some injuries may require that you do something different for a while, for example cycling instead of running. Often I can get my patients to rest their injury by just adjusting their training for a while, like limiting the distance or changing the terrain they run on or the speed they run at.

Yes, I know it’s not the same as being able to do full training, but being active helps your injury recover, means that you keep your cardiovascular fitness (= quicker comeback) and usually helps my patients to cope better mentally.

Identify the top 3 things that you like/enjoy about your favourite activity. Now see if you can find an alternative that can give you at least some of these benefits. When I was injured a few years back, I found that spinning was the only activity that gave me the same rush as running. But I had to supplement that with walking outside to get the stress relieving benefit of being in nature.

My advice for the bargaining stage: Use relative rest – work with someone who can help you identify how to adjust your training programme to maintain as much of your fitness (and sanity!) as possible.

Of course injury can make you feel VERY low

Being injured can shake your faith. I’m not talking about spiritual faith. I’m talking about your faith in your body. I’ve been there myself and I experience this with my patients on a weekly basis.

It can feel as if your body will never heal and that you’ll never be able to run or swim or walk again. But never is a very long time and in my experience most sports injuries do heal – some just take a VERY long time.

Most people underestimate how long the body takes to heal. This is why it can be reassuring to chat with someone who can help you understand exactly what is normal for your specific injury and how long you can expect it to take to recover.

Did you know that a simple muscle strain takes at least 4 weeks to heal? That’s a whole month. A severe muscle tear can take 12 weeks (3 months). This is because the body first has to absorb all the torn muscle fibres and then replace them with new strong ones…and this takes time.

So if your injury is still painful or you can’t yet run after 3 weeks, it doesn’t mean that you have a bad injury that won’t ever heal. It may actually be healing exactly as expected.

There are always certain milestones that I would expect my patients to achieve within a certain timeframe and these differ depending on the type and the severity of the injury. Knowing that you’re hitting the right targets can be very reassuring.

Top tip – mark your projected injury recovery timeline out on a calendar. It will help you keep things in perspective. And make sure that you celebrate your small victories. Write down things that you can do this week/month that you couldn’t do last week/month so that you can look back at this when you find yourself thinking that things will never change.

My advice to limit the low mood stage: Seek advice early on so that you know what is normal and what to expect. Keep a diary and celebrate every small step forward. Your body will heal – you just need to give it the chance to do so.

Acceptance makes my life easy!

Oh boy is it easy to treat someone when they’ve full-on embraced acceptance. They are usually receptive to anything I say and willing to try any other cross training activities that will keep them fit.

Acceptance is not just about accepting that you’re injured – more importantly it’s about accepting/believing that you will get back to full health if you do the right things. Accepting that you will get back to running if, for a little while, you cycle or swim instead. Accepting that you will be able to run fast again if you keep your runs easy for a while. Accepting that you will be able to run the rest of this year’s races properly if you withdraw from this one.

My advice for the accepting phase: Accept that your body will heal because you’re doing all the right things for it.

Let me know if you have any questions. Need more help with an injury? You can consult me online via Skype/Zoom video call for a diagnosis of you injury and a treatment plan tailored to your specific needs.

Best wishes

Maryke

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ResearchGate